Diabetes related blindness and renal failure can be
reduced, research finds

From Medical Center Public
Relations

People who develop type 2 diabetes at an early age can
substantially reduce their rates of blindness and kidney failure in later
life by tightly controlling their blood-sugar level, according to
researchers at the Medical Center and the Veterans Administration Medical
Center in Ann Arbor.

Those who get diabetes later in life, however, may
gain only small benefits from tight control and may well choose not to
undergo the difficult treatment regimens needed to achieve it.

The
research findings will be published in the Nov. 1 issue of the Annals of
Internal Medicine.

Approximately nine out of 10 diabetics have type 2
diabetes, which means their pancreases produce some insulin, but not
enough to meet their needs.

Previous research demonstrated that
intensive medical treatment has substantial benefits for people with type
1 diabetes-so called "juvenile-onset" diabetes-but the value of tight
control of blood sugar in type 2 diabetics has been more controversial.

In the United States, about 8 million people are diagnosed with
diabetes, which is the No. 1 cause of blindness, renal failure and
amputation in industrialized nations.

The research suggests how those
devastating complications might be reduced.

People who develop type 2
diabetes at a relatively early age-before age 50 to 55, for example-are at
far greater risk of ultimately losing their vision and kidney function
than those whom the disease strikes later. If people with early onset of
type 2 diabetes can maintain a near-normal blood-sugar level, however,
their lifetime risk of diabetes-related blindness will be significantly
decreased, the researchers found.

"We need to devote more attention to
this high-risk group," says Rodney Hayward, associate professor of
medicine and public health and director of the Center for Practice
Management & Outcomes Research at the VA Medical Center. "Much of the
high cost of diabetes-in both human suffering and dollars and cents-is due
to complications which could have been prevented early on."

For
patients in one health maintenance organization the researchers studied,
in fact, intensified medical care for less than 20 percent of all
diabetics-those at the highest risk-could eliminate more than 80 percent
of the preventable blindness.

"It is important to note, however, that
about half of diabetics get diabetes after age 60, and they are generally
at low risk of complications if they maintain moderate blood sugar
control," says Sandeep Vijan, the lead investigator on the project and an
Agency for Health Care Policy & Research fellow at the time the research
was conducted. Although strict blood sugar control would further reduce
risk for those with late-onset diabetes, the benefits would be
small-generally decreasing the risk of complications by less than one in
100.

In addition, Vijan says, it often is difficult to achieve strict
blood sugar control. "Several new medications can help most type 2
diabetics maintain moderate control of their blood-sugar level without the
use of insulin," he said. "However, high-risk patients, those who require
tight blood sugar control to reduce future health complications, often
will need insulin therapy and closer monitoring and more medical attention
than most diabetics typically receive today."

That, the researchers
point out, creates a policy issue for the government and insurance
companies.

The research was supported by the Department of Veterans
Affairs and the Agency for Health Care Policy & Research. Vijan and
Hayward conducted the research with Timothy Hofer, assistant professor of
internal medicine.